364806290-6-10-2019-12-CC-CYAS-BCZVLP-20190610163215

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364806290
Report Date: 06/10/2019
Date Signed: 06/10/2019 04:32:30 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME:	HAIRSTON-LANE FAMILY CHILD CARE		FACILITY NUMBER:	364806290
ADMINISTRATOR:	HAIRSTON-LANE, TOMIKA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 247-7364
CITY:	APPLE VALLEY	STATE: CA	ZIP CODE:	92308
CAPACITY:	14	CENSUS: 8	DATE:	06/10/2019
TYPE OF VISIT:	Annual/Random	ANNOUNCED	TIME BEGAN:	02:38 PM
MET WITH:	Tomika Hairston-Lane		TIME COMPLETED:	04:39 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Claretta Yates conducted an unannounced visit at the Hairston-Lane home and met with licensee Tomika Hairston-Lane The purpose of the visit was to conduct an Annual/Random Inspection. Licensee is license to provide care and supervision for a LargeFamily Child Care for the capacity of 14 children. There are currently 16 children enrolled in the family child care. Present during the time of this inspection is both licensee, 1 minor daughter age 16, 4 day care children ages 9, 7, 3, 2 and 4 foster children ages (2) 5, 4, 6 months. Pre licensee residing in the home on is both licensees, 1 minor daughter,1 adult son and 4 foster children. Per licensee all adults residing in the home has a Criminal Record Clearance. Licensee and LPA toured the areas of the home utilized for the Family Child Care to ensure the home is incompliance with Community Care Licensing Title 22 Regulations. The facility days and hours of operation are Monday-Friday 6:00AM-6:00PM. Licensee has a Resource Family Approval Certificate for the capacity of 4 foster children dated 05/07/19.] The home is set-up as follows: This is a single story house with 4 bedrooms, 2 bathrooms, kitchen/dining room, living room, den, laundry room, enclose patio (day care room) and attached garage. Per Licensee the den, 1 bathroom. enclosed patio(day care room)and backyard is utilized for the family child care areas. Per licensee off-limit areas of the home is the living room, kitchen, 4 bedrooms, 1 bathroom, laundry room and attached garage.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Claretta Yates	TELEPHONE: (661) 568-8081
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: HAIRSTON-LANE FAMILY CHILD CARE	FACILITY NUMBER: 364806290
	VISIT DATE: 06/10/2019

NARRATIVE

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The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, poisons, detergents/cleaning compounds, medicines and hazardous items that can pose a danger to children. LPA observed all items are made inaccessible to children during the time of this inspection. LPA observed age appropriate safe toys and napping equipment on the premises. Per licensee children nap in the den on mats. LPA observed all electrical outlets made inaccessible to children with safety covers.

LPA tested hot water at a safe temperature between 105-120 degrees. Per licensee, there are no weapons or firearms on the premises. LPA did not observe a swimming pool or bodies of water on the premises. LPA observed in the backyard 2 swing set which are securely anchored in the ground, 2 locked stored sheds, and age appropriate safe toys. The backyard is fenced.

Incidental Medical Services (IMS) were discussed. Per licensee, the facility is not currently providing IMS. LPA informed licensee to refer to IMS information in the Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www/ada.gov/childqanda.htm.

LPA observed the required fire extinguisher (2A10BC) fully charged, smoke detectors and carbon monoxide devices tested operable.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Claretta Yates	TELEPHONE: (661) 568-8081
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2019

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: HAIRSTON-LANE FAMILY CHILD CARE	FACILITY NUMBER: 364806290
	VISIT DATE: 06/10/2019

NARRATIVE

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The First Aid Kit was observed complete with supplies and first aid manual.
LPA observed both licensees has current Pediatric CPR and First Aid Training with expiration dates of 08/19/2019. Licensees have taken the Preventive Health and Safety Training. Licensees have On-Line Mandated Reporter Training dated 06/07/19. Licensees have proof of being immunized against pertussis and measles. Licensees provided a written statement declining the influenza vaccination. Per licensee transportation will be provided for children. LPA observed licensees valid California driver license with the expiration date of 09/23/2023 (Reginald Lane) and 02/25/2020 (Tomika Hairston-Lane) vehicle insurance with expiration date 04/01/2019 and vehicle registration with the expiration date of 01/16/2020. Per licensee meals and snacks are being provided to children.

LPA reviewed 4 children’s records. LPA reviewed the child care facility roster and the fire drills, earthquake drills log and documentation for both.

The following information was discussed with the licensee:
· Mandatory Forms for the children’s files and provider’s files.
· Requirements for fire drills, earthquake drills and documentation for both.
· Role and responsibilities of being a mandated reporter was discussed.
· Licensees was made aware that it is their responsibility to know and review updates/regulations and forms online at www.ccld.ca.gov as well as anyone who assists in providing care.
· The licensing department must have the facility’s phone number. If the phone number is changed, the licensing department must be notified.
· Licensee is aware that all adults 18 years and older living in the home or visiting for extended periods of time should have criminal background clearances. Failure to comply will result in Civil Penalty assessments.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Claretta Yates	TELEPHONE: (661) 568-8081
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2019

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: HAIRSTON-LANE FAMILY CHILD CARE	FACILITY NUMBER: 364806290
	VISIT DATE: 06/10/2019

NARRATIVE

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· On January 1, 2018 or before March 30, 2018, a person who, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the on-line mandated reporter training and shall complete renewal mandated reporter training every two years. @www.mandatedreporterca.com
· AB 290 - for each new license issued, at least one director or teacher at a child care center or family child care home shall have at least one hour of childhood nutrition training;
· Senate Bill AB 2231 Civil Penalty Amount Changes. Changes Effective 7/1/2017.
· Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). **In addition; A copy of this report must be provided to the authorized representatives of all currently enrolled children and any newly enrolled child for the following 12 months.
· The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records. The report shall be provided no later than the next business day or the next day the child is in care.
· Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty
· Licensee is made aware that Title 22 Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family child care home, and in those areas of the family day care home where children are present (24/7 ban).
· **§1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions (a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Claretta Yates	TELEPHONE: (661) 568-8081
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2019

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: HAIRSTON-LANE FAMILY CHILD CARE	FACILITY NUMBER: 364806290
	VISIT DATE: 06/10/2019

NARRATIVE

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· **Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
· Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed child care facility are aware of situations that present the greatest danger to children.
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· State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

· Licensees are advised to visit www.shotsforschool.org for Immunization information.
· Child Care Advocates: www.childcareadvocatesprogram@cdss.ca.gov

There were no deficiencies cited during this inspection.

Exit interview conducted with Licensee. A copy of this report, notice of site inspection, Licensee’s signature on this form acknowledges receipt of these rights.

Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Copies of this report must be posted for 30 days in visible location the authorized representatives of children.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Claretta Yates	TELEPHONE: (661) 568-8081
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2019

LIC809 (FAS) - (06/04)

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